The child welfare system strives to provide children and adolescents in foster care with a safe, nurturing environment through kinship and nonkinship foster care placement with the goal of either reunification with birth parents or adoption. Pediatricians can support families who care for children and adolescents who are fostered and adopted while attending to children' s medical needs and helping each child attain their developmental potential. Although this report primarily focuses on children in the US child welfare system, private and internationally adopted children often have similar needs. THE FACES OF CHILD WELFARE IN THE UNITED STATES The child welfare system strives to protect the safety of children while supporting families whose children are placed in foster care. In this document, the term "child" includes infants, children, adolescents, and young adults. The child welfare system also serves as a bridge to the primary goal of permanency through reunification or adoption. On September 30, 2018, the Adoption and Foster Care Analysis and Reporting System reported that 437 283 children and adolescents were in foster care. 1 Of these children, 262 956 entered foster care during the fiscal year of 2018, with 250 103 exiting foster care. The number of children served in the foster care system during 2018 was 687 345. There were 125 422 children waiting to be adopted, with 71 254 having parental rights terminated and 63 123 subsequently being adopted from care. Primary reasons for entering foster care include neglect (62%), parental substance use (36%), poor coping skills of the caregiver (14%), physical abuse (13%), and inadequate housing (10%). Other reasons that account for less than 10% in each category include child behavior problems, parental incarceration, parental alcoholism, abandonment, sexual abuse, child disability, relinquishment, parental death, and child alcohol and other substance use. 1 A growing number of children, estimated to be 5% to 10%